Toader Corneliu, Serban Matei, Covache-Busuioc Razvan-Adrian, Radoi Mugurel Petrinel, Aljboor Ghaith Saleh Radi, Costin Horia Petre, Ilie Milena-Monica, Popa Andrei Adrian, Gorgan Radu Mircea
Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania.
J Clin Med. 2025 Jan 5;14(1):269. doi: 10.3390/jcm14010269.
The management of multiple intracranial aneurysms presents significant clinical challenges, particularly when complicated by underlying conditions such as cerebral atherosclerosis. This case report highlights the successful treatment of a 66-year-old female diagnosed with three intracranial aneurysms located in the right middle cerebral artery (MCA), pericallosal artery, and M2 segment. The patient also had a history of systemic atherosclerosis and right-sided breast cancer, factors that increased the complexity of surgical intervention. The aim of this report is to demonstrate the efficacy of single-stage microsurgical clipping in managing multiple aneurysms with favorable outcomes in a complex patient profile. : The patient underwent right-sided pterional craniotomy for microsurgical clipping of all three aneurysms during a single-stage procedure. Two aneurysms in the MCA were clipped using Yasargil clips, and a third aneurysm located at the bifurcation of the pericallosal artery was also secured with a clip. The procedure was performed under microscopic visualization, with meticulous dissection of the atherosclerotic vessels and careful intraoperative hemostasis. Postoperative care involved proactive perioperative management, including blood pressure control and vigilant neurological monitoring. : Postoperative imaging at three months confirmed proper clip placement with no evidence of residual aneurysm filling or ischemic complications. The patient exhibited a full neurological recovery, with no deficits or further complications, highlighting the effectiveness of the surgical approach in managing multiple aneurysms concurrently. : This case supports the use of single-stage microsurgical clipping as an effective treatment for patients with multiple intracranial aneurysms, even in the presence of complicating factors such as atherosclerosis. A meticulous surgical technique and perioperative management are critical to achieving favorable outcomes and reducing the risk of delayed ischemia or other postoperative complications.
多发性颅内动脉瘤的治疗面临重大临床挑战，尤其是当合并脑动脉粥样硬化等基础疾病时。本病例报告重点介绍了一名66岁女性的成功治疗，该患者被诊断出在右侧大脑中动脉（MCA）、胼周动脉和M2段有三个颅内动脉瘤。患者还有全身动脉粥样硬化和右侧乳腺癌病史，这些因素增加了手术干预的复杂性。本报告的目的是证明在复杂患者情况下，单阶段显微手术夹闭治疗多发性动脉瘤的有效性及良好结果。：患者在单阶段手术中接受了右侧翼点开颅术，对所有三个动脉瘤进行显微手术夹闭。使用Yasargil夹夹闭了MCA中的两个动脉瘤，位于胼周动脉分叉处的第三个动脉瘤也用夹子固定。手术在显微镜下进行，仔细解剖动脉粥样硬化血管并在术中仔细止血。术后护理包括积极的围手术期管理，包括血压控制和严密的神经监测。：术后三个月的影像学检查证实夹子放置正确，没有残余动脉瘤充盈或缺血性并发症的迹象。患者神经功能完全恢复，无功能缺损或进一步并发症，突出了该手术方法同时治疗多发性动脉瘤的有效性。：本病例支持将单阶段显微手术夹闭作为治疗多发性颅内动脉瘤患者的有效方法，即使存在动脉粥样硬化等复杂因素。细致的手术技术和围手术期管理对于取得良好结果和降低延迟性缺血或其他术后并发症的风险至关重要。
